肝门区肿瘤的MRI诊断和术前评估

MRI diagnosis and preoperative evaluation for hepatic hilar tumor

目的 探讨MRI在肝门区肿瘤诊断和术前评估中的价值。方法 肝门区肿瘤 42例 ,其中肝门区肝细胞癌 (HCC) 12例 ,肝门区胆管癌 (HC) 2 2例 ,肝门区转移性病变 8例。MR检查包括平扫、磁共振胰胆管成像 (MRCP)和连续动态增强。连续动态增强为 2次注射对比剂 ,首次经静脉团注钆喷替酸葡甲胺 (Gd DTPA)约 10ml ,行全肝动态增强扫描 ,延迟至 15min后 ,追加对比剂 15～ 2 0ml(0 15～ 0 2 0mmol/kg)行三维动态增强磁共振血管成像 (3DDCEMRA)。MRI表现与手术、病理进行对照。结果 (1)HCC的强化曲线以Ⅰ、Ⅱ型为主 (10 / 12 ,83 3 % ) ,HC的强化曲线以Ⅲ、Ⅳ型为主 (2 1/2 2 ,95 4% ) ,8例肝门转移病变的强化曲线呈多样化。 (2 )HCC组 2 4支门静脉中 ,3支 (12 5% )门静脉侧壁虫噬样侵犯 ,4支 (16 7% )门静脉癌栓 ;HC组 44支门静脉中 ,5支 (11 4% )局部管壁受侵 ,8支(18 2 % )向心性缩窄 ,11支 (2 5 0 % )门静脉闭塞 ;肝门转移病变组仅 1例门静脉右支缩窄。 (3 )术前MRI对肝门肿瘤能否切除总的评估准确率为 85 2 % (3 3 / 4 2 ) ,HCC组评估准确率为 83 3 % (10 / 12 ) ,HC组评估准确率为 86 4% (19/ 2 2 )。结论 MR平扫。

Objective To investigate the value of the all-in-one MR scanning in the diagnosis and preoperative evaluation of hepatic hilar tumor. Methods Forty-two cases of hepatic hilar tumors were examined with a 1.5 T superconductive MR system, including hepatocellular carcinoma (HCC, n =12), hilar cholangiocarcinoma (HC, n =22), and hilar metastasis ( n =8). Besides the precontrast MRI and MRCP, all cases underwent consecutive dynamic contrast-enhanced MR scanning. The whole liver dynamic contrast-enhanced MR was performed with the first bolus injection of Gd-DTPA (10 ml), and 15 minutes later, 3D DCE MRA was performed with additional injection of Gd-DTPA (15-20 ml)(0 15-0 20 mmol/kg) The contrast time-signal curve of liver and tumor was drawn, and arterial and portal venous phase images were reconstructed with MIP MR appearances were compared with surgical findings and pathology Results Consecutive DCE scanning was successfully performed in all cases The contrast time-signal curve of HCC showed type Ⅰ and Ⅱ (10/12, 83 3%), and the curve of HC showed type Ⅲ and Ⅳ (21/22, 95 4%), whereas the curve of metastasis was various The difference of tumor peak transit time (PT) between HCC group and HC group was significant ( P <0 05) The vascular invasion in HCC group appeared as arterial-portal vein fistula (2/12,16 7%), portal vein infiltration (3/24, 12 5%), and occlusion by tumor thrombosis (4/24, 16 7%) However, the vascular invasion in HC group showed spiral artery (5/22, 22 7%), portal vein infiltration (5/44, 11 4%), portal vein central narrowing (8/44, 18 2%) and occlusion (11/44, 25 0%) All metastasis had no vascular invasion expect one gall bladder carcinoma with right portal vein infiltration The accuracy of preoperative evaluation with MRI in HCC group and HC group was 83 3% (10/12) and 86 4% (19/22), respectively The accuracy of preoperative evaluation in all hilar tumors was 78 6% (33/42) Conclusion Consecutive DCE was a safe and useful technique in MR examination of liver All-in-one MR, including precontrast MR, MRCP, and consecutive DCE, could give more useful information about differential diagnosis and preoperative evaluation in hilar tumor